It’s hard to believe that it’s been over a decade since TV personality, Katie Couric, agreed to have her screening colonoscopy nationally televised in March of 2000. She was and is passionate about early detection of colorectal cancer (CRC), having suffered the loss of her husband, Jay Monahan, in 1998 at the age of 42. There’s nothing like the loss of a loved one to cancer at a young age to firebrand the ugly stamp of cancer’s potential for devastation on your mind. It was my Godmother’s suffering and death from an aggressive form of breast cancer in her mid-40′s (while I was in high school) that helped me decide on my future career as an oncologist. In any case, Ms. Couric’s televised colonoscopy resulted in a subsequent ~20% increase in the number of Americans receiving the screening test shortly thereafter, according to a group of doctor scientists from the University of Michigan who reported their research in the Annals of Internal Medicine in 2003: http://www.ncbi.nlm.nih.gov/pubmed/12860585. That single bold decision by Katie Couric had a huge positive impact on the public health of Americans across the country.
Currently, most CRC screening guidelines recommend a baseline colonoscopy at age 50 for people without a family history of the disease. I decided to have my first test earlier than age 50 (I’m 43) since, being adopted, I don’t know my entire family history. Seeing a handful of 40 something young men and women with locally advanced rectal cancer as patients over the past month sealed my decision. I had my colonoscopy yesterday and all went smoothly. Here’s what I learned that might be beneficial for people contemplating whether to have this screening test:
1. The prep is not fun, but not as horrible as many people would lead you to believe. My gastroenterologist (GI specialist) and his partners use a regimen that consists of bisacodyl laxative (Dulcolax) pills in the afternoon on the day prior to the procedure, followed by a bottle of polyethylene glycol (Miralax) dissolved in two large bottles of light-colored Gatorade (I used lemon-lime) in early evening. These two drugs produced results a few hours later. You definitely should be in a comfortable setting close to a bathroom, since you’ll be in there for bowel movements every 15-30 minutes or so for at least a few hours. Since I worked the day before my colonoscopy, I started the prep a bit later and was in the bathroom until just after midnight. Starting the prep earlier in the afternoon may increase the chances of a better night’s sleep. The final part of the prep recommended by my doctor is a saline laxative called magnesium citrate and is, in my opinion, the least palatable. It clears out any bile left in the colon, ensuring good visualization for the doctor during the colonoscopy. The worst part for me was the lack of solid food throughout my work day (would not do well on a hunger strike!). However, I got by on chicken broth, apple juice, and water ice.
2. The colonoscopy itself should be relatively easy. Sedation in my case was with propafol, and it was perfect. I was “out” quickly, didn’t remember anything of the procedure, “woke up” quickly, and had my wits about me within 15-20 minutes, with no nausea, headache, or residual pain. Other than some slight residual effect of the laxative prep, the remainder of the day was uneventful. While I would not have wanted to be making important business, legal or medical decisions, I was able to function well and enjoy the rest of the day at home.
Colorectal cancer (CRC) is one of what I term “the big four,” with the others being cancers of the breast, lung, and prostate. Together, these four major cancers account for about 750,000 cancer diagnoses in the U.S. each year, of which CRC accounts for about 150,000. More than 50,000 Americans died of CRC in 2010; that’s more deaths from CRC than from either breast or prostate cancer. In all but the most aggressive cases of CRC, it takes years to progress from a precancerous polyp or early invasive cancer that can be cured with surgery alone, into an advanced CRC that may require major surgery, chemotherapy, and or radiation with a lower chance for cure.
The bottom line is that anyone who meets screening guidelines (for most adults without family history of polyposis or CRC, that’s age 50) and has medical insurance and/or other financial means to undergo a screening colonoscopy should have this test. The risks of the procedure are low, with rare chance of severe side effects (like bowel perforation, etc). After a clear colonoscopy, without evidence of pre-cancer or invasive cancer, most people don’t need another colonoscopy for a decade.
- Patrick Maguire MD